What proof would a new gold standard be to Mary X and Sandy Y? Is Mary X part of the average in the clinical trial? Or is Sandy Y part of the average in the clinical trial? In other words, if it would help Mary X, whould it help Sandy Y?

At present, clinical trials are highly empirical, they test drugs on general populations and then look for a clincial response and a treatment effect that is not likely to be a chance result. However, the side effect of this is inflexibility, some patients may unnecessarily be exposed to inferior experimental therapies.

A problem with the empirical approach is it yields information about how large populations are likely to respond to a treatment. Doctors don't treat populations, they treat individual patients. Because of this, doctors give treatments knowing full well that only a certain percentage of patients will receive a benefit from any given medicine. The empirical approach doesn't tell doctors how to personalize their care to individual patients.

The number of possible treatment options supported by completed randomized clinical trials becomes increasingly vague for guiding physicians. Even the National Cancer Institute's December 7, 2006 official cancer information website states that no data support the superiority of more than 20 different regimens in the case of metastatic breast cancer, a disease in which probably more clinical trials have been done than any other type of cancer.

More clinical trials have not produced more clear-cut guidance, but more confusion in this situation. It is more difficult to carry out clinical trials in early stage breast cancer, because larger numbers of patients are needed, as well as longer follow-up periods. But it is likely that more trials would lead to the identification of more equivalent chemotherapy choices for the average patient in early stage breast cancer and in virtually all forms of cancer as well.

So, it would appear that published reports of clinical trials provide precious little in the way of "gold standard" guidance. Almost any combination therapy is acceptable in the treatment of cancer these days. Physicians are confronted on nearly a daily basis by decisions that have not been addressed by randomized clinical trial evaluation.

How much weight are people gaining on the Taxoteere with Cytoxan protocol?

Also, my doctor wants me to get a port but my friends who have previously had chemotherapy think this is overkill since I am only having 4-6 treatments, spaced 3 weeks apart. The doctor didn't mention that the port leaves a rather nasty looking scar so I am thinking it is something that he wants done more for the convenience of his staff rather than for me. I am not inclined to do it. Can anyone tell me about this? Thanks.

I am wondering if anyone has had problems with their teeth feeling strange or kind of hurting no one told me to get them checked before chemo,but I had no problems before chemo. Otherwise am doing pretty well.

Alison, I was gradually losing weight (a choice) before chemotherapy and I was able to continue during chemotherapy. It has been harder (but not impossible) on AI's -- slower, but not impossible.

Actually the scar from the port will be VERY minor once it has faded unless you form keloids. You can have badly scarred veins (not a good thing) or a very faint scar from the port. Taxanes are VERY hard on the blood vessels, which is why they want to put it into the largest one possible to dilute it as soon as possible.

I liked the one poster that reminded us that Dr. Lapook recommended WebMD, a CBS commercial partner, as a good site to access health information online. WebMD is all about marketing.

While the blogosphere offers a unique opportunity to discuss a very complex topic in an open-ended forum, not all bloggers have alert readers. The blogosphere is clogged with posts that are silly, just plain nasty, and too often simply not true. Simple flamming commentary.

The interactive format allows rapid responses to medical and health care issues which frequently intertwine moral, ethical and legal concerns, and provides valuable feedback and commentary not available through traditional media.

Blogs are increasing the visibility of laypeople medical experts, who share tips about treatment and care giving from personal experience, and others have relied on them for straight talk about their health issues and bloggers often provide links to other blogs they favor.

Most of us are being responsible though it takes a great deal of character and perseverence. It is important that people study and manage their own problems. The blogger voice lives on and challenges an establishment of medicine and health care that is imperfect, but more importantly, refuses not to question conventional wisdom when it is wrong and accepted without thinking.

I have no problem with questioning conventional wisdom if it's done responsibly. I'm not sure who you think here "refuses to question conventional wisdom," but attacking others will not make your points stronger.

If you want to make your points stronger, footnote more precisely so those of us who question *everything* they read online can double-check your statements.

I am wondering if anyone has had problems with their teeth feeling strange or kind of hurting no one told me to get them checked before chemo,but I had no problems before chemo. Otherwise am doing pretty well.

What type of medicines are you taking? Are any of them biophosphates - ie Zometa? It is a known fact that these biophosphates are playing havor in peoples mouths causing tooth pain, infections, teeth rotting out, root canals which don't heal and other mouth problems. It is called ONJ - or ostenecrousis of the jaw or dead jaw bone. Usually no warnings= just boom, a problem. You need to have a dental surgeon look at your mouth and determine what is going on. It can get pretty bad and pulling teeth is NOT an option, as most likely th wound will not heal or close up. Check with your doctor, oncologist or den your dentist if you think something is amiss with your teeth.God Luck.

After my chemo finished i had 2 teeth just drop out with days of each other! never had any problems with them - broke off at the gums. This was within 4 months of finishing. I am sure it must of been because of the chemo, never had it happen before or since.

<quoted text>What type of medicines are you taking? Are any of them biophosphates - ie Zometa? It is a known fact that these biophosphates are playing havor in peoples mouths causing tooth pain, infections, teeth rotting out, root canals which don't heal and other mouth problems. It is called ONJ - or ostenecrousis of the jaw or dead jaw bone. Usually no warnings= just boom, a problem. You need to have a dental surgeon look at your mouth and determine what is going on. It can get pretty bad and pulling teeth is NOT an option, as most likely th wound will not heal or close up. Check with your doctor, oncologist or den your dentist if you think something is amiss with your teeth.God Luck.

In fact it is really important to keep your teeth in good shape, but the only thing these drugs have been tied to is -- rarely -- serious jaw problems.

That said, Zometa can reverse bone density problems quite quickly AND prevent the spread of breast cancer. It is not reasonable to talk only about the problems.

What proof are clinical trials to the individual?What proof would a new gold standard be to Mary X and Sandy Y? Is Mary X part of the average in the clinical trial? Or is Sandy Y part of the average in the clinical trial? In other words, if it would help Mary X, whould it help Sandy Y?At present, clinical trials are highly empirical, they test drugs on general populations and then look for a clincial response and a treatment effect that is not likely to be a chance result. However, the side effect of this is inflexibility, some patients may unnecessarily be exposed to inferior experimental therapies.A problem with the empirical approach is it yields information about how large populations are likely to respond to a treatment. Doctors don't treat populations, they treat individual patients. Because of this, doctors give treatments knowing full well that only a certain percentage of patients will receive a benefit from any given medicine. The empirical approach doesn't tell doctors how to personalize their care to individual patients.The number of possible treatment options supported by completed randomized clinical trials becomes increasingly vague for guiding physicians. Even the National Cancer Institute's December 7, 2006 official cancer information website states that no data support the superiority of more than 20 different regimens in the case of metastatic breast cancer, a disease in which probably more clinical trials have been done than any other type of cancer.More clinical trials have not produced more clear-cut guidance, but more confusion in this situation. It is more difficult to carry out clinical trials in early stage breast cancer, because larger numbers of patients are needed, as well as longer follow-up periods. But it is likely that more trials would lead to the identification of more equivalent chemotherapy choices for the average patient in early stage breast cancer and in virtually all forms of cancer as well.So, it would appear that published reports of clinical trials provide precious little in the way of "gold standard" guidance. Almost any combination therapy is acceptable in the treatment of cancer these days. Physicians are confronted on nearly a daily basis by decisions that have not been addressed by randomized clinical trial evaluation.

WOW -- Nuthin' gets by you, gdp! People are individuals!

We ALL know that there is no guarantee. We ALL know that different tumors respond to different combinations.

Now we even know that tumor characteristics can change over time. They're actively developing a way to make tumors that are not HER sensitive, sensitive, to add that as a treatment option. What a tumor is in March may not be what it is in July.

So are you opposed to either research or asking questions because we don't have all the answers yet? Is that it?

I received Taxotere and Cytoxan -- almost five years ago. It seems to have worked for me. So this combination is nothing new.

Oncologists do the best they can. They also did the best they could years ago when your wife died. I understand your anger, but they still don't have all the answers. Without all the answers they can only play the numbers. It's not fun, feeling like a giant slot machine with your life on the line, but all they can do is the best they can do.

How much weight are people gaining on the Taxoteere with Cytoxan protocol?Also, my doctor wants me to get a port but my friends who have previously had chemotherapy think this is overkill since I am only having 4-6 treatments, spaced 3 weeks apart. The doctor didn't mention that the port leaves a rather nasty looking scar so I am thinking it is something that he wants done more for the convenience of his staff rather than for me. I am not inclined to do it. Can anyone tell me about this? Thanks.

How much weight are people gaining on the Taxoteere with Cytoxan protocol?Also, my doctor wants me to get a port but my friends who have previously had chemotherapy think this is overkill since I am only having 4-6 treatments, spaced 3 weeks apart. The doctor didn't mention that the port leaves a rather nasty looking scar so I am thinking it is something that he wants done more for the convenience of his staff rather than for me. I am not inclined to do it. Can anyone tell me about this? Thanks.

A chemoport is a wonderful thing, if you are having more than 3 chemotherapy sessions. I have had 27 chemo IV and about 18 blood tests from the same small almost invisible chemoport on my right side, just by the side of my neck. It can also be removed if you have a successful cure from any of the cancers. Please trust the doctor who advised you to have a chemoport inserted. The insertion is under local and takes minutes. God Bless and may your cancer be gone.

<quoted text>A chemoport is a wonderful thing, if you are having more than 3 chemotherapy sessions. I have had 27 chemo IV and about 18 blood tests from the same small almost invisible chemoport on my right side, just by the side of my neck. It can also be removed if you have a successful cure from any of the cancers. Please trust the doctor who advised you to have a chemoport inserted. The insertion is under local and takes minutes. God Bless and may your cancer be gone.

A chemoport is a VERY good idea if using any Taxane. The drug is harsh and can damage blood vessel walls. The port injects this drug into a heavy blood flow which safely dilutes it very rapidly. IMO it should not be used without a port. It's not overkill. It's protecting you.

We don't like to think about the harshness of these treatments but it's why they can have so many side effects. A port can protect your body from damage. It's no big deal to have it put in, and no big deal to have it removed.

Tell me when this thread is updated:

Add your comments below

Please note by submitting this form you acknowledge that you have read the Terms of Service and the comment you are posting is in compliance with such terms. Be polite.
Inappropriate posts may be removed by the moderator. Send us your feedback.